Rotary Laser Printable Membership Card On-Line Order Form

Laser Membership Card Order Form

ORDER INFORMATION

Membership Card Format	Quantity	Package Price	Total

Laser Printable Cards (10/package)		$9.90/10pk
Laser Template Software		$25.00
Imprinted Cards		$1.99
Magnetic Rotary member pin		$3.25
Rotary member pin		$1.60

		Sub Total
	7% Sales Tax (Illinois residents only)
	Shipping charges will be added
		ORDER TOTAL

SHIP TO ADDRESS

Club Name:
Secretary's Name:
Street Address:

City, State, Zip Code:		,
Province (Outside USA):
Country:
Phone Number:
Fax Number:
E-mail Address for Order Confirmation:

CREDIT CARD INFORMATION:

Type of Card:

Account Number:

SEC Code:

Expiration Date:

	/		/
Mo		Day		Year

Name on the Card:

Billing Street Address:

City, State, Zip Code:

Province (Outside USA):

Country:

and

(Will ship within 48 hours)

Parker Systems, Inc.
20989 Middleton Drive
Lake Zurich, Illinois 60047-8098

(800) 253-5100 - (847) 726-8600 - Fax 726-8610